If you meet the criteria as priority group 1A or 1B, as defined by the Department of State Health Services, you may pre-register with the Department of Public Health, using the form below, to receive the COVID-19 vaccine as available to DPH. You will be placed on a waiting list and will be contacted (phone, email, or text) when vaccines become available on a first come, first serve basis.
Please check your Inbox and Junk/Spam email folders for the confirmation email containing a copy of your form.
Be aware this may take several weeks due to limited supplies.
Is your employer enrolled as a COVID-19 vaccine provider?
What statement best describes your daily work?
Do you consent sharing the information provided with COVID-19 vaccine providers to get the vaccine?